Harm reduction hones home in YellowknifeNeedle exchange, methadone maintenance program among practices currently in use
Northern News Services
Published Friday, November 28 2014
At one time, Lydia Bardak said she was attending a funeral every month for the people she knew living on the streets of Yellowknife - all of them dying far too young.
The Yellowknife Health and Social Services Authority is building a guideline around harm reduction practices across all departments, says Nathalie Nadeau, director of social programs. - Elaine Anselmi/NNSL photo
Consumption of alcohol-based liquids not intended for drinking is a problem Bardak - now the executive director of the John Howard Society of the Northwest Territories - said, is cutting many lives short.
Alcohol maintenance programs have had proven success across Canada, she said, by encouraging those consuming mouthwash, hairspray and other products to switch to drinkable alcohol - rather than solely preaching abstinence.
In Yellowknife, Bardak said there is a definite need for an alcohol maintenance program, but hesitates to group those with harm reduction practices.
"I'm true to (harm reduction's) original intent - a medical model designed to exchange needles for safe injection - in Vancouver, they even had safe crack pipes so people weren't sharing them around," said Bardak.
"That's what harm reduction means to me; reducing the harm of binge drinking and non-beverage alcohol consumption certainly reduces harm but is not 'harm reduction'."
Currently, Yellowknife Health and Social Services Authority (YHSSA) is working toward establishing a clear outline of what harm reduction means in its purview, and ways to support those who practise it.
"I've seen the (YHSSA) annual reports and been to meetings around it," said Bardak.
"They're keeping it as a vague, broad catchall but if it is gong to be that vague, I want someone to ask, are they going to fund alcohol management?"
In December, YHSSA senior management will review a first draft of guidelines around harm reduction practices, from the newly formed Harm Reduction Committee.
"We don't have any overarching strategy coming from the Department of Health and Social Services," said Nathalie Nadeau, YHSSA director of social programs.
"So, we thought let's do one for our organization - an over-arching strategy that's (apparent) throughout the department. It doesn't matter if you're working in child and youth (services), or a nurse performing safe injection, it is all led through this framework."
In the authority's view, harm reduction encompasses measures that increase safety, without forcing people to fully abstain from potentially dangerous behaviour. This includes Bardak's example of encouraging people to drink alcohol intended for consumption, rather than more toxic products.
"If we can't eliminate the risk, how can we reduce the risk where the client is at that time?" said Nadeau.
Over the summer, YHSSA hired a student to assess the existing harm reduction practices within the authority, and perform a literature review of other successful models in B.C. and the Yukon.
"What transpired is that people know what harm reduction is and we have a program in place, not a formalized program, but we do have a program in place in this philosophy of harm reduction," said Nadeau.
"In order to develop any further programming, we need a framework. In the framework, we need to state what our vision of philosophy and care in harm reduction is."
Currently, within the authority, this includes methadone maintenance clinics - administering controlled doses of methadone in place of heroin or other narcotics - and syringe exchanges programs. Nadeau said having official regulations around harm reduction would allow the authority to develop those programs further.
In the YHSSA's broad view of harm reduction, Nadeau said addiction is not the only area in which the philosophy carries through, also giving the example of providing condoms in schools.
"It's not something new, but something that we'll mostly endorse to say, 'yes, we are dedicated to doing harm reduction,'" said Nadeau.
In order to serve clients most effectively, Ruth Gillingham, Yellowknife Salvation Army captain, said incorporating different philosophies and models is necessary.
"If we become entrenched in one model, we're actually doing that to our detriment," said Gillingham. "At the Salvation Army, our desire, our goal, our philosophy, is we would love people to engage in abstinence.
"That would be great but we recognize the road to that can be harm reduction."
In the shelter, Gillingham said people who use substances are still able to access services, as long as they aren't a danger to themselves or others.
"Instead of us being entrenched in certain ways, we're trying to have client engagement and help teach people different ways," said Gillingham. "It's being able to recognize how they can have more health or safety in the practise of what they're doing."
The City of Yellowknife is also looking at a proven model of offering assistance without demanding abstinence. Pending federal government funding, which should be approved before the end of the year, Dayle Hernblad, the city's homelessness co-ordinator, said the Housing First program, which provides subsidized housing for the homeless, will be established in Yellowknife.
"Housing First is basically meeting the client where they're at," said Hernblad.
"It's not an abstinence-based model, so Housing First is getting the client into housing and then wrapping services around him or her to keep them housed ... if the client is still using substances, then they should be able to continue using substances within legal definitions. They don't have to be abstinent, clean and sober to get a house."
The program has been implemented in major cities across Canada and Hernblad said it is viewed as a successful response to ending homelessness.
By having a safe and stable place to live, Hernblad said, people can begin to address their addiction problems.
Addressing the issues that lead to addiction, whether to alcohol or drugs, is what Bardak points to as a key piece in saving many lives.
"They're self-medicating because of the pain they carry, mostly around trauma," said Bardak. "Until we can heal that, people are self-medicating."
Hearing of various forms of abuse or witnessing abuse among those she has met on the street, Bardak said there needs to be a better way of working with people who are self-medicating - also a reason there is such a need for alternatives to abstinence-based programs.
"While it shortens their lives, so many of these folk die way too young, it's kind of saving them because they could potentially be suicidal if not self-medicating," said Bardak.
"In their own way, it's a survival tactic."